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Gradel KO. Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review. J Clin Med 2023; 12:6132. [PMID: 37834777 PMCID: PMC10573484 DOI: 10.3390/jcm12196132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark; ; Tel.: +45-21-15-80-85
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Lin G, Feng Q, Zhan F, Yang F, Niu Y, Li G. Generation and Analysis of Pyroptosis-Based and Immune-Based Signatures for Kidney Renal Clear Cell Carcinoma Patients, and Cell Experiment. Front Genet 2022; 13:809794. [PMID: 35281845 PMCID: PMC8908022 DOI: 10.3389/fgene.2022.809794] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Pyroptosis is a programmed cell death caused by inflammasomes, which is closely related to immune responses and tumor progression. The present study aimed to construct dual prognostic indices based on pyroptosis-associated and immune-associated genes and to investigate the impact of the biological signatures of these genes on Kidney Renal Clear Cell Carcinoma (KIRC). Materials and Methods: All the KIRC samples from the Cancer Genome Atlas (TCGA) were randomly and equally divided into the training and testing datasets. Cox and Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis were used to screen crucial pyroptosis-associated genes (PAGs), and a pyroptosis-associated genes prognostic index (PAGsPI) was constructed. Immune-associated genes (IAGs) related to PAGs were identified, and then screened through Cox and LASSO regression analyses, and an immune-associated genes prognostic index (IAGsPI) was developed. These two prognostic indices were verified by using the testing and the Gene Expression Omnibus (GEO) datasets and an independent cohort. The patients’ response to immunotherapy was analyzed. A nomogram was constructed and calibrated. qRT-PCR was used to detect the expression of PAGs and IAGs in the tumor tissues and normal tissues. Functional experiment was carried out. Results: 86 PAGs and 1,774 differentially expressed genes (DEGs) were obtained. After intersecting PAGs with DEGs, 22 differentially expressed PAGs (DEPAGs) were included in Cox and LASSO regression analyses, identifying 5 crucial PAGs. The PAGsPI was generated. Patients in the high-PAGsPI group had a poor prognosis. 82 differentially expressed IAGs (DEIAGs) were highly correlated with DEPAGs. 7 key IAGs were screened out, and an IAGsPI was generated. Patients in the high-IAGsPI group had a poor prognosis. PAGsPI and IAGsPI were verified to be robust and reliable. The results revealed patients in low-PAGsPI group and high-IAGsPI group may be more sensitive to immunotherapy. The calibrated nomogram was proved to be reliable. An independent cohort study also proved that PAGsPI and IAGsPI performed well in prognosis prediction. We found that the expression of AIM2 may affect proliferation of KIRC cells. Conclusion: PAGsPI and IAGsPI could be regarded as potential biomarkers for predicting the prognosis of patients with KIRC.
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Affiliation(s)
- Gaoteng Lin
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qingfu Feng
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fangfang Zhan
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Fan Yang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuanjie Niu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gang Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Ueshima J, Maeda K, Ishida Y, Shimizu A, Inoue T, Nonogaki T, Matsuyama R, Yamanaka Y, Mori N. SARC-F Predicts Mortality Risk of Older Adults during Hospitalization. J Nutr Health Aging 2021; 25:914-920. [PMID: 34409971 DOI: 10.1007/s12603-021-1647-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the association between SARC-F scores and the in-hospital mortality risk among older patients admitted to acute care hospitals. DESIGN Single-center retrospective study. SETTING A university hospital. PARTICIPANTS All consecutive patients aged older than 65 were admitted and discharged from the study hospital between July 2019 and September 2019. MEASUREMENTS Relevant patient data included age, sex, body mass index, nutritional status, fat-free mass, disease, activities of daily living (ADL), duration of hospital stay, SARC-F, and occurrence of death within 30 days of hospitalization. The diseases that caused hospitalization and comorbidities (Charlson Comorbidity Index; CCI) were obtained from medical records. The Eastern Cooperative Oncology Group-performance status (PS) was used to determine ADL, and the in-hospital mortality rate within 30 days of hospitalization as the outcome. RESULTS We analyzed 2,424 patients. The mean age was 75.9±6.9 and 55.5% were male. Fifty-three in-hospital mortalities occurred among the participants within the first 30 days of hospitalization. Patients who died in-hospital were older, had poorer nutritional status and severer PS scores, and more comorbidities than those who did not. A SARC-F score of ≥4 predicted a higher mortality risk within those 30 days with the following precision: sensitivity 0.792 and specificity 0.805. There were significantly more deaths in Kaplan-Meier curves regarding a score of SARC-F≥4 than a score of SARC-F<4 (p<0.001). Cox proportional hazard analysis was used to identify the clinical indicators most associated with in-hospital mortality. SARC-F≥4 (Hazard Ratio: HR 5.65, p<0.001), CCI scores (HR1.11, p=0.004), and infectious and parasitic diseases (HR3.13, p=0.031) were associated with in-hospital mortality. The SARC-F items with significant in-hospital mortality effects were assistance with walking (HR 2.55, p<0.001) and climbing stairs (HR 2.46, p=0.002). CONCLUSION The SARC-F questionnaire is a useful prognostic indicator for older adults because a SARC-F ≥4 score during admission to an acute care hospital predicts in-hospital mortality within 30 days of hospitalization.
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Affiliation(s)
- J Ueshima
- Keisuke Maeda, M.D., Ph.D. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan, Phone: +81-562-46-2311; FAX: +81-562-44-8518, E-mail:
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Mańczak R, Kurzyna M, Piłka M, Darocha S, Florczyk M, Wieteska-Miłek M, Mańczak M, Torbicki A. Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters. Diagnostics (Basel) 2020; 10:diagnostics10090644. [PMID: 32867292 PMCID: PMC7555680 DOI: 10.3390/diagnostics10090644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022] Open
Abstract
Effective targeted therapy of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) requires regular risk stratification. Among many prognostic parameters, three hemodynamic indices: right atrial pressure, cardiac index, and mixed venous saturation are considered critically important for correct risk classification. All of them are measured invasively and require right heart catheterization (RHC). The study was aimed to verify assumption that a model based on non-invasive parameters is able to predict hemodynamic profile described by the mentioned invasive indices. A group of 330 patients with pulmonary hypertension was used for the selection of the best predictors from the set of 17 functional, biochemical, and echocardiographic parameters. Multivariable logistic regression models for the prediction of low-risk and high-risk profiles were created. The cut-off points were determined and subsequent validation of the models was conducted prospectively on another group of 136 patients. The ROC curve analysis showed the very good discrimination power of the models (AUC 0.80-0.99) in the prediction of the hemodynamic profile in the total validation group and subgroups: PAH and CTEPH. The models indicated the risk profiles with moderate sensitivity (57-60%) and high specificity (87-93%). The method enables estimation of the hemodynamic indices when RHC cannot be performed.
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Affiliation(s)
- Rafał Mańczak
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ Otwock, ERN-LUNG-Pulmonary Hypertension, ul. Borowa 14/18, 05-400 Otwock, Poland; (M.K.); (M.P.); (S.D.); (M.F.); (M.W.-M.); (A.T.)
- Correspondence: ; Tel.:+48-510116306
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ Otwock, ERN-LUNG-Pulmonary Hypertension, ul. Borowa 14/18, 05-400 Otwock, Poland; (M.K.); (M.P.); (S.D.); (M.F.); (M.W.-M.); (A.T.)
| | - Michał Piłka
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ Otwock, ERN-LUNG-Pulmonary Hypertension, ul. Borowa 14/18, 05-400 Otwock, Poland; (M.K.); (M.P.); (S.D.); (M.F.); (M.W.-M.); (A.T.)
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ Otwock, ERN-LUNG-Pulmonary Hypertension, ul. Borowa 14/18, 05-400 Otwock, Poland; (M.K.); (M.P.); (S.D.); (M.F.); (M.W.-M.); (A.T.)
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ Otwock, ERN-LUNG-Pulmonary Hypertension, ul. Borowa 14/18, 05-400 Otwock, Poland; (M.K.); (M.P.); (S.D.); (M.F.); (M.W.-M.); (A.T.)
| | - Maria Wieteska-Miłek
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ Otwock, ERN-LUNG-Pulmonary Hypertension, ul. Borowa 14/18, 05-400 Otwock, Poland; (M.K.); (M.P.); (S.D.); (M.F.); (M.W.-M.); (A.T.)
| | - Małgorzata Mańczak
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, ul. Spartańska 1, 02-627 Warsaw, Poland;
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, ECZ Otwock, ERN-LUNG-Pulmonary Hypertension, ul. Borowa 14/18, 05-400 Otwock, Poland; (M.K.); (M.P.); (S.D.); (M.F.); (M.W.-M.); (A.T.)
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Della Seta M, Collettini F, Chapiro J, Angelidis A, Engeling F, Hamm B, Kaul D. A 3D quantitative imaging biomarker in pre-treatment MRI predicts overall survival after stereotactic radiation therapy of patients with a singular brain metastasis. Acta Radiol 2019; 60:1496-1503. [PMID: 30841703 DOI: 10.1177/0284185119831692] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Marta Della Seta
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - University Medicine, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius Chapiro
- Department of Radiology, Yale University, New Haven, CT, USA
| | - Alexander Angelidis
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
| | - Fidelis Engeling
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - University Medicine, Berlin, Germany
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Zou J, Li Q, Kou F, Zhu Y, Lu M, Li J, Lu Z, Shen L. Prognostic value of inflammation-based markers in advanced or metastatic neuroendocrine tumours. ACTA ACUST UNITED AC 2019; 26:e30-e38. [PMID: 30853807 DOI: 10.3747/co.26.4135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background The role of systemic inflammation-based markers remains uncertain in advanced or metastatic neuroendocrine tumours (nets). Methods Systemic inflammatory factors, such as levels of circulating white blood cells and other blood components, were combined to yield inflammation-based prognostic scores [high-sensitivity inflammation-based Glasgow prognostic score (hsgps), neutrophil:lymphocyte ratio (nlr), platelet:lymphocyte ratio (plr), high-sensitivity inflammation-based prognostic index (hspi), and prognostic nutritional index (pni)], whose individual values as prognostic markers were retrospectively determined. Univariate and multivariate analyses were used to examine the association of inflammatory markers with overall survival (os). Results The study included 135 patients. Univariate analysis revealed that elevated white blood cell count, elevated neutrophil count, low serum albumin, elevated high-sensitivity C-reactive protein, and elevated hspi, hsgps, and nlr scores were significantly associated with worse os. Multivariate analyses demonstrated that, apart from pathology grade and original site of the tumour, elevated hspi (p = 0.004) was an independent prognostic factor for worse os. Conclusions In the present study, elevated pretreatment hspi was observed to be an independent predictor of shorter os in patients with inoperable advanced or metastatic net. The hspi might thus provide additional guidance for therapeutic decision-making in such patients.
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Affiliation(s)
- J Zou
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - Q Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - F Kou
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - Y Zhu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - M Lu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - J Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - Z Lu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - L Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
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Wijesinghe HD, Thuvarakan P, Samarasekera A, S Lokuhetty MD. Prognostic indices predictive of short-term disease-free survival of breast carcinoma patients receiving primary surgical treatment in Sri Lanka. INDIAN J PATHOL MICR 2018; 61:505-509. [PMID: 30303138 DOI: 10.4103/ijpm.ijpm_321_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Breast carcinoma (BCa) is the commonest malignancy among women worldwide and in Sri Lanka. Several prognostic indices are described for BCa. Aims To assess clinicopathological features and prognostic indices derived from routine clinical, histopathological and immunohistochemical (IHC) data, in a cohort of patients undergoing primary surgery for BCa and to determine their prognostic impact on short-term disease free survival. Setting and Design : This is a bidirectional cohort study of 208 women undergoing primary surgery for BCa at the National Hospital of Sri Lanka, from 2012-2014, excluding post-neoadjuvant chemotherapy cases. Material and Methods Clinical details, tumor size and nodal status were obtained from histopathology reports. Histopathology and estrogen/progesterone receptor and HER2 status were reviewed. Molecular subtype based on IHC was determined. Nodal ratio (number of positive nodes/total number retrieved) and Nottingham prognostic index were calculated. Follow up information was obtained by patient interviews and record review. Statistical Analysis Data was analyzed by univariate and multivariate Cox regression using SPSS19.0. Results Mean follow-up duration was 27.16 months (0.5-52 months, s = 9.35 months). 174 (82.9%) remained disease free with 19 (9%) deaths. Thirteen (6.2%) survived with metastasis and 4 (1.9%) with recurrences. On univariate Cox regression, tumor, nodal and TNM stages, nodal ratio and lymphovascular invasion (LVI) were predictive of disease free survival (DFS) (P = 0.001, P = 0.021, P = 0.022, P = 0.002, P = 0.018). On multivariate analysis TNM stage and LVI were predictive of DFS. Conclusion TNM stage and LVI were the most important predictors of short-term disease free survival in this study population, confirming that early detection of BCa at a lower stage has a significant impact on short-term outcomes.
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Steiger H, Sansfaçon J, Thaler L, Leonard N, Cottier D, Kahan E, Fletcher E, Rossi E, Israel M, Gauvin L. Autonomy support and autonomous motivation in the outpatient treatment of adults with an eating disorder. Int J Eat Disord 2017; 50:1058-1066. [PMID: 28842966 DOI: 10.1002/eat.22734] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/18/2017] [Accepted: 05/08/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Across diverse clinical problems, therapists' autonomy support has been found to increase patients' autonomous motivation for change. Being self-motivated has, in turn, been linked to superior treatment response. In people undergoing outpatient eating disorder (ED) treatment, we examined associations among ratings of autonomy support received from therapists and other carers, self-reported engagement in therapy, and clinical outcomes. METHOD Ninety-seven women with anorexia nervosa, bulimia nervosa, or a related ED provided measures of motivational status and clinical symptoms at the beginning and end of time-limited (12-16 weeks) segments of specialized treatment. At mid-treatment, patients also rated the extent to which they perceived their individual therapists, group therapists, group-therapy peers, family members, friends, and romantic partners as being autonomy supportive. RESULTS Overall, multiple regression analyses indicated autonomy support to moderate (rather than mediate) the link between initial autonomous motivation and later change in autonomous motivation-with results indicating that, independently of ED diagnosis or treatment intensity, greater perceived autonomy support (from therapists and nontherapists alike) coincided with larger increases in autonomous motivation over the course of therapy. In turn, higher autonomous motivation at end-of-therapy coincided with larger reductions in eating symptoms. DISCUSSION Findings suggest that the experience of autonomy support (from therapists and nontherapists) is associated with increasing motivation in people undergoing ED treatment, and that becoming self-motivated is linked to better outcomes. Such results indicate that support from therapists, relatives, and peers can favorably influence personal engagement in individuals undergoing ED treatment.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Jeanne Sansfaçon
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Niamh Leonard
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Danaëlle Cottier
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Emilie Fletcher
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Erika Rossi
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Lise Gauvin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Verdun, Quebec, Canada
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Monacelli F, Tafuro M, Molfetta L, Sartini M, Nencioni A, Cea M, Borghi R, Montecucco F, Odetti P. Evaluation of prognostic indices in elderly hospitalized patients. Geriatr Gerontol Int 2016; 17:1015-1021. [PMID: 27302412 DOI: 10.1111/ggi.12801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
Abstract
AIM Prognosis informs the physician's decision-making process, especially for frail older adults. So far, any non-disease-specific index has proven full evidence for routine use in clinical practice. Here, we aimed at assessing, prospectively, the calibration and discriminating accuracy of validated prognostic indices in a cohort of elderly hospitalized patients. METHODS This was a prospective observational study that enrolled elderly patients (n = 100). The patients' assessment included clinical variables, as well as the following five prognostic indices of mortality: (i) Levine index (2007); (ii) Walter index (2001); (iii) CARING (C, primary diagnosis of cancer; A, ≥ 2 admissions to the hospital for a chronic illness within the last year; R, resident in a nursing home; I, intensive care unit admission with multiorgan failure, NG, noncancer hospice guidelines [meeting ≥ 2 of the National Hospice and Palliative Care Organization's guidelines]) criteria of Fischer (2006-2011); (iv) Silver Code of Di Bari (2010); and (v) Burden of Illness Score for Elderly Persons of Inouye (2003). RESULTS Patients' clinical characteristics: 70% women (age 86.20 ± 0.69 years), 30% men (age 85.40 ± 1.07 years), Comorbidity Illness rating scale (CIRS) 4.3 ± 0.61 and Barthel Index 28 ± 0.54. Walter and Burden of Illness Score for Elderly Persons scores showed similar prediction rates when compared with the expected validated values (ancova: F = 14.00, P < 0.008). Burden of Illness Score for Elderly Persons was the most calibrated and accurate index (receiver operating characteristic curve 0.72; P < 0.02). CONCLUSIONS None of the assessed prognostic indices, in a "real world" scenario, afforded the optimal predictive accuracy (receiver operating characteristic curve 0.90); all these indices are still far from a robust answer to the prognosis in older age, reflecting a poor ability to encompass the spectrum of frailty. Effort should be made to tailor the prognostication in geriatrics, moving from a disease-centered model to a precision model, tailored to the frail phenotype. Geriatr Gerontol Int 2017; 17: 1015-1021.
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Affiliation(s)
- Fiammetta Monacelli
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Manuela Tafuro
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | | | | | - Alessio Nencioni
- Section of Oncology, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Michele Cea
- Section of Hematology, Department of Internal Medicine and Medical Specialties, (DIMI), University of Genoa, Genoa, Italy
| | - Roberta Borghi
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa and IRCCS University Hospital of San Martino, Genoa, Italy
| | - Patrizio Odetti
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
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Abstract
AIMS To evaluate the practicality of use and the effectiveness of a standard protocol for examining nephrectomy specimens for renal cell carcinoma (RCC), with emphasis on the identification of vascular invasion. METHODS A standard protocol, devised to identify the major prognostic determinants, was used to examine 79 consecutive tumours submitted to four histopathology departments. The incidence of vascular invasion found was compared with the incidence in a historical series of tumours. RESULTS The protocol proved easy to follow, and appeared to increase the incidence of observed vascular invasion (40 of 69 cases compared with 69 of 176 cases in the historical series; p = 0.059, Fishers exact test, one sided) CONCLUSIONS If pathological prognostic determinants are to be used for clinical management, then it is important that they are identified and recorded consistently. The protocol described provides a method of examining nephrectomy specimens that can be used in routine practice and would probably reliably identify recognised prognostic variables.
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Affiliation(s)
- D F R Griffiths
- Department of Pathology, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK.
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